Q:

11/28/2011
17 year old male over the past 2 months he has had about 4 episodes of swelling of his uvula. No other areas of swelling, no GI symptoms, no hives with the swelling. He wakes up with the swelling. He does not know trigger. He responds to Benadryl or Claritin. No family history of angioedema. Denies allergies to any foods or medications. He has no fever, no heartburn. He was seen 2 months ago in Pediatrics, no fever, pharynx, tonsils were erythematous, uvula swollen, no exudate on tonsils Rapid strep negative. Sent home on antihistamine, Medrol. Throat culture light growth of beta hemolytic Group G strep. No antibiotics given He was seen 3 weeks ago in ED for uvula swelling; he received no meds in ED and was sent home on Benadryl. When I saw him last week he had woken up with uvula swelling and his uvula was moderately swollen. He had no redness of uvula or pharynx, no fever, no problem breathing or talking. He had taken Claritin a few hours before I saw him and he believed the swelling was less after taking Claritin. history of asthma. Triggers include pollen, excessive exercise. No admissions Last Albuterol month ago, no controllers. History of allergic rhinitis, allergic, conjunctivitis. Triggers include dust, pollen Claritin helps.

 

His Mother's home has 1 cat for 5 years, 1 dog for 1 year, 1 Chinchila for 1 year, 2 rats for 1-2 years, rabbit for a few months. He denies pets trigger angioedema. Fathers home has smokers, no pets. He has had no uvula swelling at Father's home. He goes to Father for occasional weekends.

 

I have sent patient for various lab test:
C4 36
C1esterase inhibitor pending
IgE for individual aeroallergens positive for DF, negative for rat, dog, cat, rabbit

 

I sent him to ENT - prescribed Epi Pen

 

Please let me know what other diagnoses and work up should be considered.

A:

Thank you for your recent inquiry.

I think that you have already done due diligence in your evaluation of this patient. From your description, it appears that he is having recurrent episodes of angioedema of the uvula. As you know, the vast majority of episodes of angioedema are idiopathic, and based upon your workup, I think that you have already looked at all potential causes of angioedema in this patient.

Unfortunately, with episodes of recurrent angioedema, quite often there is very little that we can offer a patient to prevent them. However, in most instances, these episodes will subside over time.

The only further suggestion that I might have is that in patients who have an excessively long uvula, a modest amount of swelling is quite uncomfortable and on occasion, in patients with recurrent angioedema of the uvula, we have been able to improve the patient's quality of life by performing a partial uvulectomy. Therefore you might consider this if the episodes continue, and he does have an excessively long uvula.

There is a nice review of this problem which is available in its entirety online without charge. The abstract of this review is copied below.

Thank you again for your inquiry and we hope this response is helpful to you.

Emergency Medicine News:
July 2001 - Volume 23 - Issue 7 - p 7-12
In Focus
Acute Angioedema of the Uvula
Roberts, James R. MD
Abstract
Acute angioedema isolated to the uvula is a frustrating and confusing condition that most emergency physicians see a few times a year. Spontaneous swelling of the uvula is actually quite common, its etiology is usually obscure, and it's unclear whether any treatment alters the clinical course. Most cases are mild and annoying but rather inscrutable.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology